August 6, 2018Journal of Cardiovascular Translational Research174 citationsOpen Access
Mechanical Unloading by Fulminant Myocarditis: LV-IMPELLA, ECMELLA, BI-PELLA, and PROPELLA Concepts
Key Result
Mechanical circulatory support with Impella-based strategies provides effective hemodynamic stabilization and may promote disease-modifying myocardial recovery in patients with fulminant myocarditis.
Structured PICO
P
Population
A review discussing mechanical circulatory support strategies, including a case report of prolonged LV-Impella use, for patients with acute fulminant myocarditis and cardiogenic shock.
I
Intervention
Mechanical circulatory support (MCS) using left-sided Impella alone or in combination with right ventricular support devices (ECLS/ECMELLA or Impella RP/BI-PELLA), including the PROPELLA concept (LV-IMPELLA 5.0 via axillary approach for several weeks)
This review highlights the role of Impella-based mechanical circulatory support, including novel concepts like PROPELLA, for stabilizing and promoting myocardial recovery in patients with acute fulminant myocarditis and cardiogenic shock.
Limitations
- Mechanistic data demonstrating the effect of LV unloading on fulminant myocarditis are lacking
- Heterogeneity of presentation makes it difficult to determine appropriate weaning times
- Need for larger scale clinical trials to validate these concepts
Abstract
Mechanical circulatory support (MCS) is often required to stabilize patients with acute fulminant myocarditis with cardiogenic shock. This review gives an overview of the successful use of left-sided Impella in the setting of fulminant myocarditis and cardiogenic shock as the sole means of MCS as well as in combination with right ventricular (RV) support devices including extracorporeal life support (ECLS) (ECMELLA) or an Impella RP (BI-PELLA). It further provides evidence from endomyocardial biopsies that in addition to giving adequate support, LV unloading by Impella exhibits disease-modifying effects important for myocardial recovery (i.e., bridge-to-recovery) achieved by this newly termed "prolonged Impella" (PROPELLA) concept in which LV-IMPELLA 5.0, implanted via an axillary approach, provides support in awake, mobilized patients for several weeks. Finally, this review addresses the question of how to define the appropriate time point for weaning strategies and for changing or discontinuing unloading in fulminant myocarditis.